One of my favorite paintings is deceptively simple. If you were to glance at it, you’d see a jungle scene, with some plants and a couple of animals. But if you looked at it through a red filter, you would see the picture teeming with wildlife. Use a green filter, and you see only plants – a tropical rainforest. With a blue filter, the other animals and plants are gone, and instead, you see more than a dozen monkeys.
The idea here is that if you take a confusing kaleidoscope of information and you apply the right filter, what emerges is something amazing. Every story in this issue of LEAP involves applying novel filters to help us see clinically relevant subgroups. We use a variety of data and measurement filters – a multidisciplinary approach to patient evaluation in our Sjögren’s Center (see page 10), ultrasound to look at the muscles in patients with myositis (page 6), different antibodies to stratify cancer risk (page 17) and even complicated math formulas (page 2) to help us find antibody signatures in scleroderma patients – to define subgroups of patients within diseases who behave similarly.
Why is this important? Because the unique features of disease subgroups – how they manifest and how they progress – often result from distinct biological mechanisms. For too long, doctors treating rheumatic diseases have had to base their management on instinct and experience. The problem is that each physician has a limited experience – which means that many times we basically had to guess at how to treat a specific patient, using trial and error to find out what might work best.
The opposite of that is to use filters, combining our unprecedented ability to measure – using revolutionary modern tools with new data analytics powered by computers, and increasingly sophisticated algorithms – along with the powerful human intuition that comes from listening to our patients and observing how the illness behaves differently in each one. This allows us to treat and even help prevent problems in a precise and accurate way. This is precision medicine; it’s revolutionary, but
at its heart is the incredible partnership we share with our patients.
Antony Rosen, M.D.
Director, Division of Rheumatology
Vice Dean for Research